Abstract
BackgroundMechanically ventilated patients with COVID-19 have a mortality of 24–53%, in part due to distal mucopurulent secretions interfering with ventilation. DNA from neutrophil extracellular traps (NETs) contribute to the viscosity of mucopurulent secretions and NETs are found in the serum of COVID-19 patients. Dornase alfa is recombinant human DNase 1 and is used to digest DNA in mucoid sputum. Here, we report a single-center case series where dornase alfa was co-administered with albuterol through an in-line nebulizer system.MethodsDemographic and clinical data were collected from the electronic medical records of five mechanically ventilated patients with COVID-19—including three requiring veno-venous extracorporeal membrane oxygenation—treated with nebulized in-line endotracheal dornase alfa and albuterol, between March 31 and April 24, 2020. Data on tolerability and response were analyzed.ResultsThe fraction of inspired oxygen requirements was reduced for all five patients after initiating dornase alfa administration. All patients were successfully extubated, discharged from hospital and remain alive. No drug-associated toxicities were identified.ConclusionsResults suggest that dornase alfa will be well-tolerated by patients with severe COVID-19. Clinical trials are required to formally test the dosing, safety, and efficacy of dornase alfa in COVID-19, and several have been recently registered.
Highlights
Ventilated patients with COVID-19 have a mortality of 24–53%, in part due to distal mucopurulent secretions interfering with ventilation
79–88% of patients admitted to the intensive care unit (ICU) with COVID-19 require intubation and mechanical ventilation, with a mortality of 24–53% (Cummings et al 2020; Grasselli et al 2020; Richardson et al 2020; Docherty et al 2020)
The Northwell Health institutional review board that focuses on COVID-19 research approved this case series as minimal-risk research using de-identified data from routine clinical practice
Summary
Ventilated patients with COVID-19 have a mortality of 24–53%, in part due to distal mucopurulent secretions interfering with ventilation. Dornase alfa (Pulmozyme®) is recombinant human DNase 1 and a safe mucolytic that is administered in nebulized form. It is FDA-approved in combination with standard therapies for patients with cystic fibrosis to improve sputum clearance and pulmonary function (Yang and Montgomery 2018). It is used off-label as a mucolytic in other diseases, including ARDS
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
